pharma mystery

[cellio]

I don't understand the drug industry. Ok, ok, nobody does. Let me be more specific: I don't understand what's going on with one of my glaucoma drugs, Xalatan.

This drug has been on the market since 1996 without a generic option, meaning it costs more than $100 a month if you pay for it yourself (which of course most people don't, but delving into insurance-based pricing in this post would be scope creep). My co-pay is higher for a name-brand drug than for a generic, so I have personal interest in this going generic.

About a year ago word on the street was that the patent was due to expire last September, but something seems to have happened because it's now, according to the patent office, locked in until early 2011. According to my doctor, some insurance companies are applying pressure to ophthamologists, pushing them to use different drugs instead to treat this condition because of the expense. One way or another, it appears that Pfizer has about another year to collect the big bucks from customers before they have to accept that a 15-year monopoly is a pretty good run.

Given all that, I was surprised at this morning's checkup to receive not only a free sample (a month's supply) but also a card that I can use four times or up to $350, whichever comes first, getting my prescription filled. So my next four bottles of the stuff will be free. Before I use that up I'll have another checkup, at which I might score another freebie and perhaps another card. Even if the promotion is over by then, they'll have given up four months' worth of monopoly pricing on me in their final year of being guaranteed to collect it.

How is this in their interest? I'm happy to pocket the savings; I've been pouring money into keeping my glaucoma at bay for as long as I've been paying my own bills. (It was diagnosed when I was a child.) But I don't understand why I'm getting these savings at this time.

Comments

[woodwindy.livejournal.com]

They're desperately trying to build brand loyalty while they still can? I can't come up with anything else that seems even remotely plausible -- you're right, it is odd.

[cellio]

schulman (below) is on to something.

I have no brand loyalty for drugs (or much of anything else where I can't perceive a difference). If my doctor says there's equivalent, I will take the generic that costs me $10 a pop (and with the lower overall price) instead of the name brand that costs me $25 a pop. (My insurance company charges the higher co-pay for all name-brand drugs, not just the ones for which a generic is available.)

[alienor.livejournal.com]

I've had problems with one of my prescription "generics" not being equivalent. The doctor I was seeing at the time said that his patients were reporting the same thing with that particular drug, but we didn't know until the generic came onto the market.

I'm pretty wary of new generics now.

[cellio]

Yeah, if they're not equivalent, all bets are off. My doctor has high hopes in this particular case, but of course we won't know until there's actually one available that people can start testing.

[ariannawyn.livejournal.com]

YOU may have no brand loyalty (and neither do I), but a lot of people do. "Ask you doctor about [drug]..." I agree that's the only motivation I can come up with for the pharma co.

And as someone else already said, not all generics are actually equivalent to their name-brand inspiration... We ran into that with one of my kids' meds and had a brief fight with the insurance co until the prescribing doc got on our side and signed on the "brand-name specified" line of the script each time.

[alienor.livejournal.com]

*ouch* I was kinda lucky and unlucky in my case. My insurance won't cover the brand name if there's a generic, no matter what... but the generic was only available in certain doses. So the doctor wrote my script in a way that I had to get 2 x mg pills rather than 1 2x mg pill. The 2x mg pill had a generic, but the x mg pill didn't. It was weird.

[cellio]

Yeah, if they're not really equivalent that's completely different. I've had good luck with generics so far, but that's no guarantee. But when this one goes generic we're certainly going to look into it.

[schulman.livejournal.com]

I believe that the card covers your copay, but the insurance company still has a higher payment with the expensive drug than they would with a cheaper drug, so Pfizer still makes more money than they would otherwise.

"This American Life" did a story about this tactic during one of their shows about the health care industry; I don't remember which show it was, but here's an NPR story on the same subject: http://www.npr.org/templates/story/story.php?storyId=113969968

[cellio]

Oh, interesting! Thanks for that link.

So it sounds like the best use of this card (taking the long-term into account) is for me to use it as if I didn't have insurance. I might only get three months free instead of four, but I won't be helping to raise my own insurance premiums later.

[baron-steffan.livejournal.com]

There are a *lot* of these coupon programs.

They drive us nuts, frankly, mainly because folks treat them as point-of-sale coupons, and they're not. We fill the Rx, then the patient comes in to pick it up and hands the clerk the card at the counter. Now we have to cancel the transaction, reverse out the claim, input the card as a secondary insurance, bill the primary again, then process the coordination-of-benefits transaction. All while the patient is tapping their fingers on the counter. But, of course, I digress.

Mostly, they're for brand-only drugs in high teirs where there are generics in the same categoiry. I don't understand the economic mechanics, either. One of the most popular programs is for Lipitor, which has staved off a generic for *way* longer than anyone expected. You have to understand, as soon as a generic comes out, the brand market share is gone. Just...gone. Pffft. So it's in their interest to pay their lawyers whatever it takes. How they're managing to eat the coupon charges, though, that I don't quite get.

[cellio]

What is the least-disruptive way for me to use this card? I was planning on just getting the freebies at the grocery store (since I have to present the card and I've never actually been to my pharmacist's establishment, doing everything by phone and delivery instead). So I would drop off the prescription before shopping and pick up after; I can tell them I have the card when I drop off, but is there anything more I should do to make things easier?

[yuggazogy.livejournal.com]

Maybe it's a nationwide thing to keep market share in light of states being increasingly-pro medical marijuana? (supposed to be good for glaucoma, allegedly)

[cellio]

There are different manifestations of glaucoma and different drugs attack different types (or aspects of the same types). I don't know what specifically marijuana does to help glaucoma and so can't say which drug makers should be concerned. (If anyone should be concerned. They're not going to write prescriptions for the raw plant, right? I assume they'll package it in a pill or some such, which I imagine is way less exciting to the pot fans.)

[yuggazogy.livejournal.com]

My understanding is that it has been prescribed in the raw plant form for the states that currently allow it. Though a gel-cap type form would be easier to package and probably have a longer shelf life...

[cjsherwood.livejournal.com]

They're packaging it so you can smoke it. That's how it's done presently in states where it's legal.

[cellio]

Wow. I wonder if non-smokers can get a loose-leaf alternative to bake into brownies. :-)

[baron-steffan.livejournal.com]

The active principle of marijuana (chemical name: tetrahydrocannibinol, USAN (US Adopted Name, i.e. "generic drug name"): dronabinol) is available in capsules as Marinol (tm), a Schedule-III Controlled Substance to increase appetite in "wasting" diseases such as HIV/AIDS. (Yes: the "munchies" are for real!) I've dispensed it, although I currently have no patients on it.

But advocates of "medical marijuana" claims it only works for their purposes if smoked in natural leaf form. I'm skeptical, but...whatever. So the states
where it's legal permit -- in theory -- the dispensing of real weed. Who's gonna grow it, who's gonna sell it...that's another issue entirely. Don't look at me %^).